History of Optometry in Alberta
The following is a summary of the many historical events surrounding the profession of optometry and the creation of the Alberta College of Optometrists:
During the late 1800’s and early 1900’s, optometry was practiced in an unregulated fashion in Alberta by a wide variety of individuals with extremely varied competencies and skills. Sensing the need for standardization and regulation of this new profession, the Government of Alberta proclaimed the Optometry Profession Act on April 19, 1921. The original definition of optometry was:
“The practice of optometry means the examination of the human eye by the employment of subjective or objective mechanical means to ascertain the presence of defects or abnormal condition which, or the effect of which, may be corrected, relieved or remedied by the use of lenses or prism; to determine the accommodative or refractive conditions, the range of powers of vision or muscular equilibrium; to correct, relieve or remedy any such defect or abnormal condition or its effect by the adaptation or adjustment of lenses or prism; and the supplying thereof.”
This new Act resulted in the formation of the Alberta Optometric Association that was a joint organization of an association and a separate (regulatory) Board of Examiners. It also laid the framework for holding yearly Annual General Meetings, terms of office for council and a process for discipline. The annual fees could not be more than $20. On top of this were registration fees of $15 for the certificate and $2 for a copy of their certificate. Most optometrists in this era were jewelers or druggists and were not allowed to use the title “Doctor”. The first female optometrist was Dr. Boyle (who was also a chiropractor). The association tried to establish a 2-year optometry course at the University of Alberta; however, this endeavor failed due to a lack of funding and available instrumentation. The next few years were busy in terms of getting all optometrists to register with the newly formed Association, getting rid of illegal and incompetent practitioners and ensuring that all practitioners met a minimum competency standard and abided by the Code of Ethics.
Educational sessions were started by the Association in the mid-1920’s to enhance and maintain the educational and clinical qualifications of practitioners.
Optometry was excluded from a provincial Health Act that allowed districts to be formed for the purpose of availing themselves the advantage of the new Provincial Medicine Act. A formal protest to the provincial government to amend this Act to include the profession of optometry was not successful.
The revamped Optometry Bylaws were approved by the government.
The Canadian Journal of Optometry debuted. The cost was $2 for a yearly subscription.
The Edmonton Society of Optometrists was formed as a study group and the Association also hired its first legal counsel. Also, for the first time, wives were allowed to attend the Annual General Meeting banquet. The Association also registered with the International Association of Boards of Examiners in Optometry.
The Canadian Association of Optometrists (CAO) was formed. However, it took until 1948 before the CAO was incorporated with a formal Act and Bylaws.
The first part-time secretary was hired by the Association and worked out of the President’s private office.
Optometrists were the first practitioners in the province to fit rigid contact lenses in their private offices made from a material called polymethylmethacrylate.
Rural optometrists were paid by the provincial government for refractions on seniors; however, urban practitioners had to have a signed medical certificate by a physician in order to be paid by the government for the same service.
On July 01, the new Optometry Act was proclaimed. The big changes were that the Association’s Board of Examiners was to be “divorced” from the University of Alberta, optometry would be allowed to be practiced in department stores and that the government would take over the annual licensing of practitioners.
On January 12, The new College of Optometry at the University of Toronto opened with a 3-year professional program that granted students with a R.O. (Registered Optometrist) degree upon successful completion.
The Alberta government finally passed legislation that required a visual exam to be performed before a driver’s license would be issued.
The Optometry Act was amended to allow optometrists to use the title Doctor.
The first ophthalmologist that was booked to present a lecture to the optometrists at their Annual Continuing Education Conference had to withdraw from the program when his attendance was subsequently refused by the AMA, CMA and the provincial ophthalmological society.
Optometric services were included in the Albert Government Health Plan and the Association introduced mandatory continuing education.
Also in 1967, the College of Optometry moved from the University of Toronto to the University of Waterloo and granted the Doctor of Optometry (O.D.) degree to its graduates.
The federal government excluded optometry from its compulsory Federal Medicare Plan.
Optometrists were the first practitioners in the province to fit the new soft contact lenses developed earlier that year by Bausch & Lomb. In addition, the Alberta Optometry Act and Bylaws were amended to prohibit an optometrist from being held liable for giving an unfavorable driver’s license report to the Department of Motor Vehicles.
In September the first official AOA office was opened and staffed by a full-time secretary and part-time Executive Director. Before this, the AOA office was always operated from the private optometry practice of the President.
The Association participated in negotiations that launched the Extended Health Benefits for Alberta seniors.
The Optometric Assistants Association was formed. The Canadian Optometric Education Trust Fund (COETF) was also formed.
Optometrists began to fit the first soft toric contact lens that was specifically designed to correct astigmatism.
Optometrists started to officially use diagnostic pharmaceutical agents during regular and medically required eye examinations.
The Occupational Vision Program was officially launched with 6 companies on board. Previous to this, the only contract (started in the mid-60’s) was with Alberta Government Telephones (AGT).
Optometrists began to fit the first extended wear, tinted and bifocal soft contact lenses developed earlier that year by a number of contact lens companies.
Optometrists were allowed to sign certificates stating that a person was legally blind for use by Canada Revenue Agency and the CNIB.
The first de-insurance for optometric services was announced by the Government of Alberta.
On November 12, the revised Optometry Act was passed and the previous name of Alberta Optometric Association was changed to the Alberta Association of Optometrists. This Act also allowed the formation of a Practice Review Board and an Ethics Committee. One of the requirements of this new Act was to appoint Public Members to the Practice Review Board and Hearing Tribunal Committee.
Optometrists began to fit the first disposable contact lens developed earlier that year by Johnson & Johnson.
The Federal Government granted optometrists the right to be passport guarantors.
On January 01, the Alberta College of Optometrists was officially formed. This resulted in a formal split of regulatory duties from the joint regulatory and association duties of the previous Association.
Also, in 1993, a diagnostic pharmaceutical course for practitioners without this training was held in Alberta. Later that same year, a therapeutic pharmaceutical certification program was held with the didactic portion held at the University of Alberta and the clinical portion at the Northeastern State University in Tahlequah, Oklahoma. The program offered a total of 100 hours of instruction of which 60 hours were didactic and 40 hours clinical. Optometrists from Saskatchewan also participated in the same certification course.
Legislation was proclaimed to allow Alberta optometrists to be the first in Canada to treat eye and vision diseases with topical pharmaceutical agents. This year also marked the second round of de-insurance of government paid optometric eye exam benefits.
Beginning in the mid-90’s, doctors of optometry began to integrate laser assisted and 3-D imaging diagnostic equipment in their offices in order to meet changing ophthalmic standards of care for a variety of eye diseases and disorders.
On March 31, the Optometrist Profession Regulation was passed and the profession of optometry was proclaimed into the Alberta Health Professions Act. As per the requirements of the HPA, the ACO Council had Public Members appointed to council.
The Alberta College of Optometrists adopted the revised ACO Standards of Practice, Guidelines to the Standards of Practice, the ACO Code of Ethics and the new ACO Advisories.
On September 30, the revised ACO Bylaws were passed by the membership at the AGM. In addition, the college council revised their governance structure to become a policy driven board rather than an administratively driven board. New operational policies, position descriptions and governance descriptions were developed and implemented.
The Optometrists Profession Regulation was updated to reflect a change to optometric practice. The new practice areas included:
- Authorization to dispense, prescribe, sell or provide for sale all topical and oral Schedule 1 & 2 drugs within the practice of optometry.
- Authorization to manage and treat glaucoma in an independent manner.
- Authorization to order laboratory tests.
- Authorization to order and apply non-ionizing radiation in the form of ultrasound.
In order to ensure that these new areas of practice were provided in a safe, skilled and competent manner, all currently registered optometrists had to pass a Certification Course and Exam before being authorized to perform any of these new activities. In addition, the ACO Standards of Practice, the Guidelines to the ACO Standards of Practice and all of the ACO Clinical Practice Guidelines were revised and updated to reflect generally accepted and more stringent ophthalmic standards of care currently practiced by optometrists and ophthalmologists.
On January 1, 2015, the revised ACO Continuing Competence Program and ACO Continuing Education Requirements came into effect. These programs enable and encourage lifelong learning that allow all optometrists to maintain their competence throughout their careers thus improving health care for all Albertans.